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International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 1
ISSN 2250-3153
www.ijsrp.org
Impact of supplementation of drumstick (Moringa
oleifera) and amaranth (Amaranthus tricolor) leaves
powder on menopausal symptoms of postmenopausal
women
Shalini Kushwaha and Paramjit Chawla
Department of Food and Nutrition, Punjab Agricultural University, Ludhiana-141 004, India
Abstract- Physiological and psychological changes occurring
during the menopause influence both symptomatology and
sexuality. Drumstick (Moringa oleifera) and amaranth
(Amaranthus tricolor) leafy vegetables which are rich in
micronutrients are helpful. So, the study was designed to see the
effect of supplementation of dried drumstick and amaranth leaves
powder on menopausal symptoms in postmenopausal women.
Ninety postmenopausal women aged 45-60 years were selected
and divided into three groups viz. Group I, II and III having
thirty subjects in each group. The subjects of group II and III
were supplemented daily with 7g drumstick leaves powder
(DLP) and 9g amaranth leaves powder (ALP), respectively for a
period of three months in their diet. The subjects of group I was
not given supplementation. Information regarding menopause
were collected. Menopause Rating Scale was used for various
assessment and observation of postmenopausal symptoms among
subjects. The mean standard error, analysis of variance and their
statistical significance was ascertained using a computer
programme package. The data revealed that 100, 83.3 and 70.0
per cent subjects in group I (control), group II (DLP
supplementation) and group III (ALP supplementation) had
gradual cessation of periods, whereas 16.7 and 30.0 per cent of
subjects had experienced abrupt cessation of periods in group II
and group III respectively. Irregularity of periods (2-3 months)
was observed in gradual cessation of periods. Supplementation of
DLP and ALP significantly decreased the severity of
postmenopausal symptoms with decrease in total menopause
rating score by 17.0 and 11.7 per cent in group II and III
respectively. The results indicated that these plants possess
antioxidant property and have therapeutic potential for the
prevention of complications during postmenopause.
Index Terms- Amaranth leaves powder, Drumstick leaves
powder, Menopausal symptoms
I. INTRODUCTION
enopause is a unique stage of female reproductive life
cycle. In present era with increased life expectancy,
women are likely to face long periods of menopause accounting
to approximately one third of her life. The average age of
menopause in the western world is 51 years while according to
Indian Menopause Society (IMS) research, the average age of
Indian menopausal women is 47.5 years. Average age of
menopause is around 45- 55 years. So menopausal health
demands even higher priority in Indian Scenario (Pal et al 2013).
Physiological and psychological changes occurring during the
menopause influence both symptomatology and sexuality, with a
complex interplay of individual factors affecting wellbeing.
Following the menopause, the effects of urogenital ageing are
commonly apparent, with declining levels of estrogen producing
atrophic changes (Nappi and Kierepa 2010). The antioxidant
enzyme system seems to be affected in postmenopause due to
deficiency of estrogen, which has got antioxidant properties. The
beneficial effects of estrogen might be attributable to their free
radical scavenging structures. (Shrivastava et al 2005). In such
condition green leafy vegetables which are rich in micronutrients
are helpful. There are many varieties of green leafy vegetables,
which are rich in antioxidants and other essential micronutrients,
but they are discarded and are not used for human consumption.
Drumstick (Moringa oleifera) and amaranth (Amaranthus
tricolor) leaves are one of them, which are available at no cost
and are very rich in all the micronutrients (Sreelatha and Padma
2009, Anilakumar et al 2006). Hence, the present study was
designed to see the effect of supplementation of dried drumstick
and amaranth leaves powder on menopausal symptoms in
postmenopausal women.
II. METHODOLOGY
Procurement of antioxidant powders: Fresh leaves of
Drumstick (Moringa oleifera) and amaranth (Amaranthus
tricolor) were procured from Department of Vegetable Crops,
Punjab Agricultural University, Ludhiana. Fresh leaves were
sorted and washed. Washed leaves were spread and dried in oven
at 40˚C for 4-6 hours and then powdered. Powdered drumstick
leaves were named as Antioxidant powder I (DLP) and amaranth
leaves as antioxidant powder II (ALP). All other ingredients were
purchased from the local market.
Selection of subjects and supplementation: Ninety healthy
postmenopausal women aged between 45-60 years, who were not
having their menstrual period from last 1-3 years were selected
for the study. Women who had undergone hysterectomy or taken
hormone replacement therapy were excluded from the study. The
selected subjects were equally divided into three groups viz.
group I, group II and group III i.e. 30 in each group. Subjects of
group II and group III were supplemented with antioxiant
powder I (Drumstick leaves powder: 7g) and antioxidant powder
M
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 2
ISSN 2250-3153
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II (Amaranth leaves powder: 9g) in the recipes in daily diet for
three months, whereas group I was not given any
supplementation.
Analysis of menopausal symptoms: Menopause Rating Scale
(Heinemann et al 2003) was used for various assessment and
observation of postmenopausal symptoms among subjects.
Statistical analysis: The data on all the menopausal
symptoms was analyzed statistically. The mean standard error,
analysis of variance and their statistical significance was
ascertained using a computer programme package (Cheema and
Singh 1990).
III. RESULTS AND DISCUSSION
Ninety postmenopausal subjects were identified and divided
into three groups. Information regarding menopause revealed that
100, 83.3 and 70.0 per cent subjects in group I (control), group II
(DLP supplementation) and group III (ALP supplementation)
had gradual cessation of periods, whereas 16.7 and 30.0 per cent
of subjects had experienced abrupt cessation of periods in group
II and group III respectively. Irregularity of periods (2-3 months)
was observed in gradual cessation of periods. As menopause is
natural process which occurs as a part of woman’s normal aging
process. It results in atresia of almost all oocytes in ovaries,
causing increase in FSH and LH levels and thus decrease in
oestrogen levels. This decrease in production of oestrogen leads
to postmenopausal symptoms of hot flushes, insomnia, mood
changes, generalized physical and mental exhaustion as well as
vaginal atrophy, bladder problems and osteoporosis (Pal et al
2013).
Severity of menopausal symptoms before and after
supplementation
Somato-vegetative subscale
Table 1 represents severity of somato-vegetative subscale
symptoms of the subjects which includes hot flushes, heart
discomfort, sleep problems and joint and muscular discomfort.
The finding of the present study revealed that the main problem
of menopausal women was hot flushes. Majority of subjects i.e.
50 and 40 per cent in experimental group II (DLP
supplementation) and group III (ALP supplementation)
experienced very severe hot flushes before supplementation
which decreased to 30 and 26.7 per cent respectively. Malacara
et al (2002) also reported hot flushes as one of the severe
problem among postmenopausal women. Heart discomfort was
severe in 16.7 per cent subjects of group II before
supplementation which decreased to 6.7 per cent. No change was
observed for group II. It was observed that 56.7 per cent subjects
in group II and group III had very severe sleep problems which
decreased to 36.7 and 33.3 per cent respectively after
supplementation. Only 3.3 per cent subjects in each group did
not have sleep problems before and after supplementation.
Supplementation of DLP and ALP decreased severe joint and
muscular discomfort by 73.3 and 83.3 per cent to 66.7, 73.3 per
cent in group II and group III respectively. Rahman et al (2010)
reported the three most prevalent menopausal symptoms among
middle age women were joint and muscular discomfort (80.1%),
physical and mental exhaustion (67.1%) and sleeping problems
(52.2%).
Psychological subscale
Table 2 represents severity of psychological subscale
symptoms of the subjects which includes depressive mood,
irritability, anxiety and physical and mental exhaustion. It was
observed that 20 per cent subjects of group III had very severe
depressive mood before supplementation which decreased to
13.3 per cent whereas no change was observed for group II.
Irritability was found to be severe in subjects of group II (23.3
per cent) which decreased to 16.7 per cent after supplementation
whereas no change was observed for group III. Anxiety was
observed to be very severe in 36.7 per cent subjects of group II
and group III before supplementation which decreased to 26.7
and 23.3 per cent after supplementation. Supplementation of
DLP and ALP improved physical and mental exhaustion by 50
and 60 per cent to 60 and 66.7 per cent in subjects of group II
and group III respectively. Minuzzi et al (2013) reported a
heightened risk for depression during early postmenopausal years
(up to 2 years postmenopause).
Urogenital subscale
Table 3 represents severity of urogenital subscale symptoms
of the subjects which includes sexual problems, bladder
problems and dryness of vagina. Data revealed that before
supplementation 73.3 per cent subjects of group II had very
severe sexual problem which decreased to 66.7 per cent after
supplementation. It was observed that 23.3 per cent subjects of
group II had very severe bladder problems which decreased to
16.7 per cent after supplementation. Results concluded that 50
and 60 per cent subjects of group II and group III did not have
dryness of vagina which increased to 60 and 66.7 per cent
respectively after supplementation. Milsom and Molander
(1998) documented that vaginal atrophy and urogenital
complaints such as vaginal discomfort, dysuria and recurrent
lower urinary tract infections are more common in women after
menopause and more than 50% of postmenopausal women suffer
from at least one of these symptoms.
Menopause Rating Scale (MRS) scores obtained by the
subjects
MRS scores obtained by the subjects before and after
supplementation of antioxidant powder I and II is given in the
Table 4.
Somato-vegetative symptoms score
The mean scores for somato-vegetative symptoms of
subjects ranged from 8.36 to 9.36 before supplementation of
antioxidant rich powders. The mean initial scores before
supplementation were 9.36±0.34 and 8.73±0.27 for group II and
group III, respectively while change in score after
supplementation were 7.76±0.34 and 7.43±0.27 for group II
(17.1 per cent) and group III (14.9 per cent) respectively.
Decrease in scores were significant (p≤0.01) for group II and
group III . Kilaf and Kirchengast (2008) reported that with an
increasing number of births the total menopausal score as well as
the score of the somato-vegetative domain increased
significantly.
Psychological symptoms score
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 3
ISSN 2250-3153
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The mean scores for psychological symptoms of subjects
ranged from 10.16 to 11.30 before supplementation of
antioxidant rich powders while 8.83 to 10.06 after
supplementation of antioxidant rich powders. The mean initial
scores before supplementation were 11.30±0.41 and 10.16±0.37
for group II and group III respectively while significant decrease
in score after supplementation were 9.56±0.32 and 8.83±0.40 for
group II and group III respectively. Kakkar et al (2007) stated
that working women seem to suffer more from psychological
symptoms. Kilaf and Kirchengast (2008) reported that Turkish
postmenopausal women exhibited extremely high scores of all
symptoms of the menopause rating scale.
Urogenital symptoms score
The mean scores for urogenital symptoms of subjects ranged
from 6.20 to 7.90 before supplementation of antioxidant rich
powders. The mean initial scores before supplementation were
7.50±0.34 and 6.20±0.43 for group II and group III respectively
while significant decrease in score after supplementation were
6.03±0.34 and 5.90±0.44 for group II and group III respectively.
Loh et al (2005) stated increased urogenital symptoms score
among postmenopausal women compared to perimenopausal
women. Kilaf and Kirchengast (2008) reported that with an
increasing number of births the total menopausal rating scale
score as well as the score of the urogenital domain increased
significantly.
Total Menopause Rating Scale (MRS) Score
The mean total MRS scores ranged from 25.10 to 28.16
before supplementation of antioxidant rich powders The mean
initial total MRS scores before supplementation were 28.16±0.52
and 25.10±0.65 for group II and group III respectively while
significant decrease in score after supplementation were
23.36±0.51 and 22.16±0.67 for group II and group III
respectively. Song et al (2009) discussed the role of estrogen as
an antioxidant in the damage of vascular endothelial cells.
Supplementation of Klamin (algae extract) in postmenopausal
women leads to significantly decrease in plasma lipid
peroxidation with improvement in overall antioxidant system.
IV. CONCLUSION
In was concluded that consumption of drumstick leaves
powder (7g) and amaranth leaves powder (9g) per day for three
months significantly decreased the severity of postmenopausal
symptoms. Decrease in total MRS score by 17.0 and 11.7 per
cent was observed in groups supplemented with drumstick leaves
powder and amaranth leaves powder respectively. The results
indicated that these plants possess antioxidant property and have
therapeutic potential for the prevention of complications during
postmenopause. Hence, it is recommended to consume
drumstick leaves and amaranth leaves as they can improve
complications among postmenopausal women.
ACKNOWLEDGMENT
This paper was presented for Young Scientists’ Award at the
46th ANNUAL National Conference of the Nutrition Society of
India.
REFERENCES
[1] Anilakumar K R, Khanum F and Santhanam K (2006) Amelioration of
Hexachlorocyclohexane-Induced Oxidative Stress by Amaranth Leaves in
Rats. Plant Foods for Hum Nutr 61:169–73.
[2] Cheema H S and Singh B (1990) CPCSI- A computer program package for
the analysis of commonly used experimental designs. Punjab Agricultural
University, Ludhiana.
[3] Heinemann L A J, Potthoff P and Schneider H P (2003) International
version of the menopause rating scale (MRS). Health Qual Life Outcomes
1:28.
[4] Kakkar V, Kaur D, Chopra K, Kaur A and Kaur I P (2007) Assessment of
the variation in menopausal symptoms with age, education and
working/non-working status in north –Indian sub population using
menopause rating scale (MRS). Maturitas 57(3):306-14.
[5] Kilaf E and Kirchengast S (2008) Menopause between nature and culture:
menopause age and climacteric symptoms among Turkish immigrant
women in Vienna, Austria. Acta Medica lituanica 15(1):313-19.
[6] Loh F H, Khin L W, Saw S M, Jeannette J M and Ken G (2005) The age of
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[7] Malacara J, Canto D C T, Bassol S, Gonzalez N, Cacique L and
Veraramirez M (2002) Symptoms at pre- and postmenopause in rural and
urban women from three States of Mexico. Maturitas 43:11–9.
[8] Milsom I and Molander U (1998) Urogenital ageing. J of the British
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[9] Minuzzi L, Frey B N and Soares C N (2013) Depression during the
menopausal transition: An update on epidemiology and biological
treatments. J of lifelong learning in psychiatry 10(1):22-27.
[10] Nappi R E and Kierepa M K (2010) Women’s voices in the menopause:
Results from an international survey on vaginal atrophy. Maturitas 67:233-
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in perimenopause and postmenopause women above 40 years in rural area.
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[12] Rahman S A S A, Zainudin S R and Mun V L K (2010) Assessment of
menopausal symptoms using modified Menopause Rating Scale ( MRS )
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[13] Shrivastava V, Singh S, Singh N and Sapre S (2005) Status of antioxidant
enzymes and trace metals in postmenopausal women. J Obstet Gynecol
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[14] Song J Y, Kim M J, Jo H H, Hwang S J, Chae B, Chung J E, Kwon D J,
Lew Y O, Lim Y T, Kim J H, Kim J H, Kim M R (2009) Antioxidant effect
of estrogen on bovine aortic endothelial cells. J Steroid Biochem Mol Bio
117:74–80.
[15] Sreelatha S and Padma P R (2009) Antioxidant Activity and Total Phenolic
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AUTHORS
First Author- Shalini Kushwaha, Department of Food and
Nutrition, Punjab Agricultural University, Ludhiana – 141 004,
India, Email: shalinikushwaha72@gmail.com
Second Author – Chawla Paramjit, Department of Food and
Nutrition, Punjab Agricultural University, Ludhiana – 141 004,
India
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 4
ISSN 2250-3153
Table 1. Severity of symptoms in postmenopausal women (Somato-vegetative Subscale)
Symptoms
Before
After
4
3
2
1
0
Mean
4
3
2
1
0
Mean
Hot flushes
Group I
12 (40)
9(30)
-
6(20)
3(10)
2.70
11(36.7)
8(26.7)
1(3.3)
6(20)
4(13.3)
2.53
Group II
15(50)
5(16.7)
2(6.7)
4(13.3)
4(13.3)
2.77
9(30)
7(23.3)
2(6.7)
8(26.7)
4(13.3)
2.30
Group III
12(40)
9(30)
-
6(20)
3(10)
2.70
8(26.7)
9(30)
2(6.7)
8(26.7)
3(10)
2.37
Heart
discomfort
Group I
4(13.3)
7(23.3)
3(10)
10(33.4)
6(20)
1.77
4(13.3)
7(23.3)
3(10)
10(33.4)
6(20)
1.77
Group II
2(6.7)
5(16.7)
7(23.3)
4(13.3)
12(40)
1.37
2(6.7)
2(6.7)
7(23.3)
7(23.3)
12(40)
1.27
Group III
4(13.3)
7(23.3)
3(10)
10(33.3)
6(20)
1.77
4(13.3)
7(23.3)
3(10)
10(33.3)
6(20)
1.77
Sleep
problems
Group I
21(70)
-
-
8(26.7)
1(3.3)
3.07
21(70)
-
-
8(26.7)
1(3.3)
3.07
Group II
17(56.7)
4(13.3)
-
8(26.7)
1(3.3)
2.93
11(36.7)
5(16.7)
3(10)
10(33.3)
1(3.3)
2.50
Group III
17(56.7)
5(16.7)
-
7(23.3)
1(3.3)
3.00
10(33.3)
7(23.3)
7(23.3)
5(16.7)
1(3.3)
2.67
Joint and
muscular
Group I
22(73.3)
3(10)
3(10)
-
2(6.7)
3.43
22(73.3)
3(10)
3(10)
-
2(6.7)
3.43
Group II
22(73.3)
-
-
8(26.7)
-
3.20
20(66.7)
-
2(6.7)
8(26.7)
-
3.07
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 5
ISSN 2250-3153
discomfort
Group III
25(83.3)
-
-
5(16.7)
-
3.50
22(73.3)
-
3(10)
5(16.7)
-
3.30
Figures in parenthesis are percentages
4=Very severe 3=Severe 2=Moderate 1= Mild 0=None
Group I=Control Group II=DLP supplementation Group III= ALP supplementation
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 6
ISSN 2250-3153
Table 2. Severity of symptoms in postmenopausal women (Psychological Subscale)
Symptoms
Before
After
4
3
2
1
0
Mean
4
3
2
1
0
Mean
Depressive
mood
Group I
6(20)
-
9(30)
8(26.7)
7(23.3)
1.67
6(20)
-
9(30)
8(26.7)
7(23.3)
1.67
Group II
2(6.7)
4(13.3)
9(30)
-
15(50)
1.27
2(6.7)
4(13.3)
5(16.7)
4(13.3)
15(50)
1.13
Group III
6(20)
-
9(30)
8(26.7)
7(23.3)
1.67
4(13.3)
-
9(30)
8(26.7)
9(30)
1.40
Irritability
Group I
4(13.3)
7(23.3)
2(6.7)
8(26.7)
9(30)
1.63
4(13.3)
7(23.3)
2(6.7)
7(23.3)
10(33.3)
1.60
Group II
4(13.3)
7(23.3)
2(6.7)
8(26.7)
9(30)
1.63
4(13.3)
5(16.7)
4(13.3)
8(26.7)
9(30)
1.57
Group III
4(13.3)
7(23.3)
2(6.7)
8(26.7)
9(30)
1.63
4(13.3)
7(23.3)
2(6.7)
7(23.3)
10(33.3)
1.60
Anxiety
Group I
11(36.7)
2(6.7)
7(23.3)
8(26.7)
2(6.7)
2.40
11(36.7)
2(6.7)
7(23.3)
8(26.7)
2(6.7)
2.40
Group II
11(36.7)
2(6.7)
7(23.3)
5(16.7)
5(16.7)
2.30
8(26.7)
4(13.3)
8(26.7)
5(16.7)
5(16.7)
2.17
Group III
11(36.7)
2(6.7)
7(23.3)
8(26.7)
2(6.7)
2.40
7(23.3)
2(6.7)
11(36.7)
8(26.7)
2(6.7)
2.13
Physical
and mental
exhaustion
Group I
7(23.3)
-
-
3(10)
20(66.7)
1.03
7(23.3)
-
-
3(10)
20(66.7)
1.03
Group II
8(26.7)
1(3.3)
2(6.7)
4(13.3)
15(50)
1.43
7(23.3)
-
2(6.7)
3(10)
18(60)
1.17
Group III
7(23.3)
2(6.7)
-
3(10)
18(60)
1.23
7(23.3)
-
-
3(10)
20(66.7)
1.03
Figures in parenthesis are percentages
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4=Very severe 3=Severe 2=Moderate 1= Mild 0=None
Group I=Control Group II=DLP supplementation Group III= ALP supplementation
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Table 3. Severity of symptoms in postmenopausal women (Urogenital Subscale)
Symptoms
Before
After
4
3
2
1
0
Mea
n
4
3
2
1
0
Mean
Sexual
problems
Group I
22(73.3)
3(10)
3(10)
-
2(6.7)
3.43
22(73.3)
3(10)
3(10)
-
2(6.7)
3.43
Group II
22(73.3)
3(10)
3(10)
-
2(6.7)
3.43
20(66.7)
5(16.7)
3(10)
-
2(6.7)
3.37
Group III
17(56.7)
3(10)
8(26.7)
-
2(6.7)
3.10
17(56.7)
3(10)
8(26.7)
-
2(6.7)
3.10
Bladder
problems
Group I
7(23.3)
2(6.7)
4(13.3)
8(26.7)
9(30)
1.67
7(23.3)
2(6.7)
4(13.3)
8(26.7)
9(30)
1.67
Group II
7(23.3)
2(6.7)
4(13.3)
8(26.7)
9(30)
1.67
5(16.7)
-
4(13.3)
12(40)
9(30)
1.33
Group III
7(23.3)
-
4(13.3)
10(33.3)
9(30)
1.53
8(26.7)
1(3.3)
2(6.7)
4(13.3)
15(50)
1.43
Dryness of
vagina
Group I
11(36.7)
2(6.7)
7(23.3)
8(26.7)
2(6.7)
2.40
11(36.7)
2(6.7)
7(23.3)
8(26.7)
2(6.7)
2.40
Group II
8(26.7)
1(3.3)
2(6.7)
4(13.3)
15(50)
1.43
7(23.3)
2(6.7)
-
3(10)
18(60)
1.23
Group III
7(23.3)
2(6.7)
-
3(10)
18(60)
1.23
7(23.3)
-
-
3(10)
20(66.7)
1.03
Figures in parenthesis are percentages
4=Very severe 3=Severe 2=Moderate 1= Mild 0=None
Group I=Control Group II=DLP supplementation Group III= ALP supplementation
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 9
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Table 4 Menopause Rating Scale (MRS) scores obtained by the subjects before and after supplementation of antioxidant
powder I and II
Parameters
Group I (Control)
Group II (DLP
supplementation)
Group III (ALP
supplementation)
C.D. at
5%
Somato-vegetative
symptoms
Baseline
8.36a±0.40
9.36±0.34
8.73±0.27
0.79
After Exp.
8.20±0.41a
7.76±0.34
7.43±0.27c
0.38
% change
1.9
17.1
14.9
Paired t-value
1.54NS
8.08**
5.45**
Psychological symptoms
Baseline
10.36±0.54
11.30±0.41
10.16±0.37
NS
After Exp.
10.06±0.54
9.56±0.32b
8.83±0.40c
0.70
% change
2.9
15.4
13.1
Paired t-value
1.87NS
6.98**
6.42**
Urogenital symptoms
Baseline
7.90±0.38
7.50±0.34
6.20±0.43
NS
After Exp.
7.76±0.37a
6.03±0.34b
5.9±0.44c
0.11
% change
1.7
19.6
4.8
Paired t-value
1.68NS
6.06**
2.50*
Total MRS score
Baseline
26.63±0.99
28.16±0.52
25.10±0.65
NS
After Exp.
26.46±1.07a
23.36±0.51b
22.16±0.67c
0.98
% change
0.6
17.0
11.7
Paired t-value
1.05NS
14.78*
7.26*
Values represent Mean ±SE
**Significant at 1% level of significance
International Journal of Scientific and Research Publications, Volume 5, Issue 1, January 2015 11
ISSN 2250-3153
*Significant at 5% level of significance
NS-Non Significant
a significant difference between group I and II
b significant difference between group II and III
c significant difference between group III and I
